Assessing Polyvictimization in a Family Justice Center: Lessons Learned From a Demonstration Project

Abstract

There is a growing interest in developing comprehensive assessments that measure intimate partner violence (IPV) alongside other adverse events that correlate with IPV and compound its effects. One promising line of research in this area has focused on the impact of exposure to multiple types of victimization, i.e., polyvictimization. The purpose of this study is to examine the experience of administration of a polyvictimization tool from staff and client perspectives in order to inform future tool developments and assessment procedures. Qualitative interviews and focus groups with clients and staff from a family justice center who had experience with the assessment tool were used to identify strengths and challenges of the assessment too and inform future tool development. Findings demonstrate that an assessment tool provides the space for clients to talk about trauma and facilitate empowerment, while providing the opportunity for psychoeducation and service referrals. Concerns about the assessment tool included adverse reactions without proper framing and language, as well as shifting the emphasis from screening for adversities toward strengths, coping skills, and resilience. Implications for future measurement development and establishing best practices in polyvictimization assessment are discussed, with an emphasis on the benefits of social service agencies utilizing assessment tools.

Keywords

polyvictimization intimate partner violence assessment trauma-informed adverse experiences

Introduction

Intimate partner violence (IPV) is a common and consequential social problem. Some estimates indicate that 25%-35% of women and 7%-14% of men in the United States experience IPV (Black et al., 2011; Breiding et al., 2008; Tjaden & Thoennes, 2000), though other research suggests that the lifetime prevalence of IPV is roughly equal among men and women (Archer, 2000; Chan, 2011). The negative effects of IPV on adult survivors are diverse and include a greater risk of poor health outcomes such as traumatic brain injuries, chronic pain, and sleep disturbance (Breiding et al., 2008; Dillon et al., 2013; Karakurt et al., 2017; Pico-Alfonso et al., 2006; Plichta, 2004; Sorenson et al., 2014), mental health problems such as depression, post-traumatic stress disorder (PTSD), and substance use (Ansara & Hindin, 2011; Breiding et al., 2008; Eshelman & Levendosky, 2012; Goodman et al., 2016; Karakurt et al., 2017; Macy et al., 2013; Mechanic et al., 2008; Pico-Alfonso et al., 2006; Plichta, 2004), and economic problems such as unemployment, housing instability, and financial dependence (Baker et al., 2010; Lindhorst et al., 2007; Peterson et al., 2018). Research also indicates that IPV manifests in heterogeneous patterns and that survivor outcomes vary accordingly. For instance, exposure to more frequent and severe IPV is known to increase the risk of harm (Coker et al., 2005; Hines & Douglas, 2012; Lagdon et al., 2014; Lilly & Graham-Bermann, 2010).

IPV service providers are tasked with addressing immediate needs (i.e., safety, housing) as well as offering services or referrals for additional needs (i.e., mental health, employment, legal). Some research demonstrates that IPV is more prevalent among disadvantaged socioeconomic groups (Breiding et al., 2008; Conwill, 2010; Riger et al., 2014); however, others find that IPV is equally distributed among the population yet governmental and nonprofit services are more commonly accessed by those in lower SES strata (Hamby et al., 2015). These individuals may have more complex needs related to other adverse experiences such as poverty, homelessness, and family incarceration, which may compound the effects of IPV and make it more challenging for survivors to leave abusive relationships (Kulkarni, 2019; Scott-Storey, 2011). Yet practitioners typically utilize assessments that screen for only IPV excluding questions of lifetime victimization and other adverse experiences. Research in the area of polyvictimization has demonstrated that experiencing multiple types of victimization or adverse life events leads to poorer mental health and behavioral outcomes (Adams et al., 2016). Therefore, providers may improve their capacity to meet the needs of IPV survivors—particularly those from vulnerable populations—by gathering information about diverse forms of victimization in order to better connect with services inform programming.

Polyvictimization

Recently, scholars have put forward a polyvictimization hypothesis, which posits that the likelihood of poor outcomes will rise as the number of victimization types increase. According to Finkelhor et al. (2011) “Polyvictimization can be defined as having experienced multiple victimizations of different kinds […] rather than just multiple episodes of the same kind of victimization, because this appears to signal a more generalized vulnerability” (p. 3). This account assumes that, holding the total amount of victimization constant, experiencing multiple types of victimization predicts poorer outcome than does a single type of victimization. In other words, it may not be just the dosage of victimization that matters; it may also be the variety.

Most polyvictimization research to date has focused on exposure to multiple forms of abuse and neglect in childhood and adolescence. These studies suggest that polyvictims are more likely than single-type victims to experience trauma-related symptoms and other mental and behavioral health disturbances (Adams et al., 2016; Finkelhor et al., 2007; Ford et al., 2010; Lee et al., 2020). Compared to children who experience a single form of trauma, polyvictims also appear to be at risk of multiple forms of trauma in adulthood, including IPV (Fiorillo et al., 2013). Scholars have started to consider polyvictimization in adults (DeKeseredy et al., 2019; Ross et al., 2019; Sabina & Straus, 2008; Willie et al., 2017), though empirical evidence remains in short supply. The current study addresses this knowledge gap by analyzing data from a formative evaluation of one Family Justice Center (FJC) that piloted a polyvictimization assessment tool (PAT) as part of a federally funded initiative.

Polyvictimization Measures

Given the nascent state of the adult polyvictimization literature, best practices in screening and assessment have yet to emerge. Most important for practitioners is the question of what aspects of polyvictimization are important to ask clients in order to meet their needs and connect to services. There are, however, many validated IPV screening tools that capture multiple forms of IPV, including the 4-item HITS (Hurts, Insults, Threatens, Screams; Sherin et al., 1998), the 3-item Abuse Assessment Screen (McFarlane et al., 1992), the 3-item Partner Violence Screen (Feldhaus et al., 1997), and the 2-item Woman Abuse Screening Tool—Short Form (Halpern et al., 2005). Among the more comprehensive assessments that are available, the most widely used are the Conflict Tactics Scale (Straus, 1979) and Revised Conflict Tactics Scale (CTS2; Straus et al., 1996). The CTS2 comes in 39-item and 20-item versions that can be used to collect self-report and partner-report data in five IPV domains: negotiation, psychological aggression, physical assault, sexual coercion, and injury. Another good example of a multifaceted IPV assessment is the Controlling and Abusive Tactics scale (Hamel et al., 2015), which was developed as a gender-inclusive measure of partner violence, abuse, and control.

Broader assessments have also been developed to measure not only IPV but also other risk factors that are often correlated with IPV. For example, as an extension of the adverse childhood experiences (ACEs) framework, Mersky et al. (2020) developed a measure of adverse adult experiences that incorporates multiple forms of IPV along with other adversities such as partner substance use, poverty, homelessness, and discrimination. Additional assessments such as the Life Events Checklist (Gray et al., 2004) and Traumatic Live Events Questionnaire (Kubany et al., 2000) are available to measure exposure to IPV and other potentially traumatic events throughout the life course. Moreover, just as expanded ACE assessments are now available to capture a broader array of childhood adversities (Mersky et al., 2017; Finkelhor et al., 2011), adult polyvictimization assessments may be enhanced by incorporating adversities such as poverty, homelessness, and immigration-related trauma that create additional barriers for clients and compound the effects of IPV (Kulkarni, 2019; Scott-Storey, 2011). However, few broad-based measures have been developed to comprehensively assess IPV and other proximal risk factors in adulthood such as partner alcohol use and substance misuse, household crime, and housing insecurity (Capaldi et al., 2012; Crane, et al., 2016; Wildeman et al., 2012). One notable exception is the Adult Experiences Survey (Mersky et al., 2018), a seminal measure of adverse adult experiences that assesses multiple forms of IPV along with related forms of victimization and environmental risk. Assessments that include broad-based definitions of victimization and adversity can help practitioners identify immediate needs (i.e., housing, immigration-status) as well as make referrals to address immediate and secondary needs.

Administration Concerns

In addition to considering what experiences to measure, recommendations are needed to guide how to measure polyvictimization. Commonly cited barriers to assessment include logistical challenges such as the length and timing of administration (Rose et al., 2011; Trevillion et al., 2012). Many providers carry large caseloads that restrict the amount of time that they can devote to assessment and, even when polyvictimization is a likely concern, clients often present with other needs that warrant immediate attention. In some instances, it may be prudent to focus on immediate safety risks and other basic needs at first, while reserving a more comprehensive assessment of adversity and trauma for later in the service episode. Yet, because many clients disengage from services prematurely, the likelihood that the information will be gathered decreases the longer the assessment is delayed. Furthermore, if such data are to be collected, there should be a clear purpose and connection to direct services within the agency or referrals to an external provider (Blodgett, 2012). Polyvictimization assessments should arguably be paired with structured assessments of client functioning and complementary service and referral protocols, especially among client populations that face significant barriers to care (Topitzes et al., 2019). However, many communities lack sufficient referral outlets, while even well-resourced communities often lack coordinated systems of care.

Professional discomfort with or resistance to asking sensitive questions is another common assessment barrier. Some providers express concerns that trauma assessments may be stigmatizing or result in client discomfort, which may ultimately disrupt the client-provider relationship (Bruce et al., 2018; Finkelhor, 2018; Sprague et al., 2012). Their discomfort may stem partly from a lack of training to develop competencies in trauma assessment (Lotzin et al., 2018; Rose et al., 2011; Salyers et al., 2004) and from a lack of awareness that most individuals can tolerate sensitive questions without experiencing significant distress (Mersky et al., 2019; Black et al., 2006; Walker et al., 1997). Taken together, there are several challenges that practitioners face when conducting assessments with clients—including asking sensitive questions, timing and time to adequately complete, and adequate referrals to connect with for client needs. Practitioners may benefit from asking about lifetime victimization in order make appropriate referrals to help clients address unhealed trauma.

Study Aims

The purpose of this study is to examine the experience of polyvictimization tool administration from both staff and client perspectives in order to inform future assessment procedures, tool refinements, and agency policies and supports. The adult polyvictimization literature is a new area of development, and assessment tools that examine adverse experiences outside of IPV can have practical implications for practitioners and agency programming. Our research presents findings from a federally funded project that was completed at a FJC located in an urban area of the upper Midwest. The overarching goal of the three-year project was to promote the integration of trauma-informed practices into FJCs, with a specific aim of piloting a PAT. The project featured a mixed methods evaluation that contributed to the development and implementation of the tool. In the following sections, we describe the project’s setting and focal population and the process of developing, implementing, and analyzing the tool. We then present original results from an analysis of qualitative data that were gathered to examine provider perspectives on their experiences while administering the tool along with client perspectives on their experiences while completing the tool with their service providers. Key themes extracted from the results are then used to inform recommendations for polyvictimization screening and assessment practices.

Methodology

Site Description

The data for this study were collected by one of six FJC grantees that participated in an evaluation of a federal demonstration initiative that was funded by the U.S. Justice Department’s Office for Victims of Crime (OVC). The study site is one of the nation’s largest and most comprehensive FJCs, and it serves predominantly low-income, racial/ethnic minority clients in an urban setting. The FJC is headed by a nonprofit domestic violence service agency that coordinates activities among 14 colocated agencies, including nonprofit organizations, justice system representatives, law enforcement, mental health practitioners, civil legal providers, school professionals, child advocacy professionals, workforce development professionals, and alternative wellness providers. By colocating services across multiple sectors under one roof, the FJC minimizes challenges that often result from having to navigate complex and decentralized human service systems. For example, FJCs are designed to reduce the number of times that IPV survivors must recount their stories as well as the number of steps and amount of time it takes to locate the support they need. The model also helps to remove barriers to care (e.g., transportation) while increasing the efficiency of referrals between service providers (Gwinn et al., 2007).

The FJC is housed in a 75,000 square foot facility that is centrally located in a city district and readily accessible by public transportation. Approximately 76.9% of the IPV survivors who seek services at the FJC are female, a large proportion of whom have children (80.2%). Reflecting the demographic composition of the surrounding communities, nearly 80% of the survivors self-identify as racial/ethnic minority, with African Americans representing nearly 60% of the client base. A large majority of clients are economically disadvantaged, with nearly 80% reporting household incomes below $15,000.

Historical data collected by the lead domestic violence agency offer insights into the clients’ lifetime experiences of polyvictimization. The agency routinely gathers qualitative and quantitative data from select clients to promote continuous quality improvement at the Center, and during these semistructured interviews participants are asked to complete the Adult Experiences Survey (Mersky et al., 2018) to assess IPV and other adult adversities. Initial client interviews are typically completed within one month of being connected to the Center for services. Between December 2016 and September 2019, all 83 participants that completed the Adult Experiences Survey during the interview process reported at least one form of IPV; most had been physically abused (97.6%) or emotionally abused (96.4%), while 49.4% had endured sexual IPV. In addition to partner violence, most clients reported having a current or former partner/spouse who had a substance abuse problem (79.5%), a mental health problem (71.1%), or who had been incarcerated or in jail (74.7%). Other common adversities reported included discrimination (80.7%), homelessness (80.7%), and crime victimization (67.5%).

Clients are also asked complete the Childhood Experiences Survey (Mersky et al., 2017), which provides information about exposure to ACEs and other potentially traumatic events before age 18. Data collected from 82 women showed that more than half had endured physical abuse (61.0%), sexual abuse (61.0%), and emotional abuse (75.6%), while experiences of emotional neglect (36.6%) and physical neglect (20.7%) were also common. Other indicators of household adversity were also highly prevalent, including parent/caregiver substance abuse problems (63.4%) and witnessing domestic violence (58.5%). In sum, agency data collected from a convenience sample indicate that most of the clients served by the FJC have endured many forms of victimization and other adversities throughout the life course.

Development of the Polyvictimization Assessment Tool

All six OVC awardees were asked to participate in an iterative process of developing a comprehensive PAT. The OVC partnered with a national technical assistance provider and an evaluation team from a public university that headed the process of developing the tool in collaboration with the six FJC grantees. An initial review of existing IPV measures and more comprehensive assessments of adversity and potentially traumatic events was used to develop a draft of the PAT, which was then reviewed and refined over multiple phases following feedback received from the FJCs.

The final version of the PAT contained a section on trauma events outlining 26 separate types of potentially traumatic experiences (See Appendix for full list). Sample items related to interpersonal violence included (a) assault/battery by a parent, caregiver, partner or relative, (b) strangulation or positional asphyxia, and (c) sexual abuse/assault by a parent, caregiver, partner or relative. The PAT also measured many other harmful events and conditions such as poverty, homelessness, bullying, discrimination as well as immigration-induced and system-induced trauma, thereby capturing a representative set of adversities that might be experienced by diverse groups. For each of the 26 items, participants were asked whether the events had occurred prior to age 18 (i.e., childhood), after age 18 (i.e., adulthood), and in the last year. In addition to assessing 26 forms of victimization, the PAT included 18 items that were used to record different types of trauma symptoms such as anxiety, hypervigilance, impulsivity, self-harm, and suicidality. Again, respondents were asked to indicate whether they had experienced the symptoms in childhood, adulthood, and in the last year. A completed PAT required a response to every question, though assessors had the discretion to omit questions that they deemed to be inappropriate.

Implementation of PAT proceeded in two phases at the FJC project site. The first pilot phase occurred in April and May 2018, and the full implementation of the PAT occurred from December 2018 through May 2019. Eligible participants included a convenience sample of newer and long-term clients with an IPV history who received different services from the FJC. The PAT was administered by four client advocates—staff at the domestic violence service agency who establish ongoing relationships with participants. This assessment protocol was designed to reduce the likelihood that participants would experience significant discomfort and to ensure that the assessment could be completed in a more conversational manner as a part of service delivery. Advocates administering the PAT began by describing the purpose of the assessment and informing participants their participation was voluntary, meaning that they could choose not to answer a question or end the conversation without impact on service delivery. Staff also could complete the assessment over multiple sessions, if necessary, and they were encouraged to use the information to suggest the services and referrals that they provided to clients.

Study Sampling and Procedures

Participants in this qualitative study were FJC staff who administered the PAT and clients who completed an initial version of the assessment during a pilot phase in April through May 2018 or a revised version between December 2018 and April 2019. Potential client participants were sampled from the list of 57 individuals who completed the PAT and indicated they were interested in providing feedback. In total, 10 clients participated in interviews (n = 4) or a focus group (n = 6). All four staff members who administered the PAT agreed to participate in a focus group to describe their perceptions of the PAT and the assessment process. Client participants were all women of varying racial/ethnic and socioeconomic backgrounds, and staff were all women of varying racial/ethnic backgrounds.

Interviews and focus groups were conducted in private rooms to protect participant confidentiality, and they were audio recorded to ensure that participants’ comments were accurately preserved and transcribed. Focus groups lasted 75 minutes and interviews were approximately 45-60 minutes long. The interview guide for staff included questions on overall perceptions of the PAT and the assessment process, as well as the potential benefits for clients. Clients also shared their perceptions of the PAT and the assessment process, and they were asked how this information might enhance staff knowledge and improve agency services. Participants were also asked about whether there were additional services that the FJC could provide that would better address their needs. All study protocols were approved by the Institutional Review Board at the University of Wisconsin - Milwaukee.

Analytical Procedure

Qualitative analysis began by transcribing each interview and focus group. Analysis for each group of participants occurred separately. Two of the researchers developed a coding scheme of keywords based on the interview questions as well as commonly occurring phrases. Based on the principles of grounded theory (Glaser & Strauss, 1967), the coding process was iterative in developing categories and refining until themes emerged. To enhance methodological rigor, multiple researchers coded some of the transcripts independently and met to compare consistency. We also conducted the interpretive stages of coding, combining lower order codes into more abstract codes together, continuing to refine these higher order codes, discussing disagreements when occurring.

Initial coding was conducted by examining chunks of text for common phrases and words (i.e., keywords) used by participants. Next, we used axial coding to identify initial patterns in phrases and terms used and relationships between codes to reduce the data to common categories (e.g., context of assessment, trauma, helping self or others). Finally, thematic mapping was used to determine relationships between categories, which assisted in the development of final themes based upon superordinate ideas emerging from the categories (e.g., trust, client-driven, empowerment). The researchers examined connections between themes and categories to identify commonalities among participants’ perceptions of the trauma assessment. Additionally, the researchers assessed commonalities and differences between information provided clients and staff. Negative cases, or a lack of consensus on ideas, were compared to overall emerging patterns, and are acknowledged in the findings below.

Findings

Themes From Clients

Trust and safety. Participants reported that having conversations about trauma could be an emotionally charged experience, and they emphasized the need to have established trust with staff. Most clients felt that it was necessary to feel safe before discussing trauma experiences with advocates or agency staff. Therefore, most reported that the trauma assessment should occur when clients are further along in their healing process rather than when they are in crisis or first seeking services to meet basic needs. Underscoring the tensions between asking questions too soon or waiting too long, a few participants believed that assessment should occur at intake to help increase client awareness of cycles of violence in their lives.

Clients also emphasized that how staff talk with them about trauma is key to helping them feel safe and empowered. All clients expressed that the client advocates who completed the PAT were compassionate, caring, and empathetic during the conversation. These traits were expressed through staff body language and affect (i.e., “energy”), oral communication (e.g., tone, language), and active listening techniques (e.g., eye contact, appearing engaged), which helped to establish trust and feelings of safety.

Assessment context and process. Another way that staff helped to promote client trust and safety is by setting the context before administering the assessment. Many participants reported that it was important for staff to use clear language when describing the purpose of the PAT and to explain who would have access to the information and how client confidentiality would be protected. Several also recommended that, because some clients experience self-blame, shame, and guilt associated with their traumatic experiences, staff should preface the PAT with messages aimed at mitigating these feelings and reducing the likelihood of discomfort or adverse reactions. For instance, some clients suggested communicating that the assessment “offers some snapshots of your life, it doesn’t define you.” Further, some emphasized that the language “snapshots of your life” should be communicated because they were concerned that the PAT labelled them as a “lifelong abuse victim.”

All participants felt that, once the trauma assessment begins, the process should be integrated into a broader and more holistic conversation about the clients’ experiences. The themes of client autonomy and empowerment also emerged, and almost all participants recommended offering clients the choice of which questions to start with, how and whether to answer the questions, and when to take breaks. All clients felt that the PAT was beneficial to complete, albeit for different reasons. Some cited the benefits of talking about their trauma experiences, including increased awareness of victimization patterns, signs of danger, and unresolved trauma that continues to affect them. In addition to increasing their own awareness, several participants indicated that the assessment process provides staff with important information, and most emphasized that the assessment process can be a cathartic, empowering experience for themselves and other clients. Moreover, by sharing their histories, many respondents hoped to serve as an example of resilience for their children and other IPV survivors, and they hoped that it would lead to improved services for other clients.

Key questions to ask. When asked which life events were important for staff to assess, participants listed the following in order of frequency: housing/homelessness, strangulation, financial abuse, sexual assault, bullying, discrimination, and human trafficking. Thus, they acknowledged the relevance of gathering information about other adversities in addition to asking about experiences of IPV. Moreover, many participants reported that it is useful to gather information about childhood adversities such as child maltreatment and sexual assault, which they believed could help clients gain greater awareness of unhealed trauma and how past events affect current behavior. Some participants also mentioned that asking about trauma symptoms was important because that information could help to inform service referrals. All participants indicated that it was helpful that the PAT items provided examples and definitions of life events and symptoms to ensure that client responses are valid.

Although all participants felt that a polyvictimization assessment could be beneficial to clients, some expressed concerns that the PAT exclusively focused on negative life events and symptoms. Some stated that after asking questions about traumatic events, the ensuing conversation should focus on coping and resilience. They maintained that this strengths-focused discussion could improve the overall experience for clients, especially those that might be prone to self-blame or feelings of shame. Moreover, several respondents reiterated that, while there is value in asking about a client’s history of traumatic events, it might be more important to focus on immediate needs if the assessment is administered at intake or early in the course of services.

Themes From Staff

Benefits of the assessment. Among the potential benefits of assessing client polyvictimization, all staff members mentioned that it can be therapeutic and empowering for a client to tell their story to a nonjudgmental provider in a safe space. Contrary to common professional concerns related to asking clients questions about trauma, staff emphasized that many clients want to disclose their experiences and have their voices heard. Moreover, staff indicated that clients were motivated to tell their stories, not only as part of their own healing journey, but also because other clients might benefit from knowing that there are women who have had similar experiences. Staff also acknowledged that asking clients questions about trauma can lead to strengths-based conversations about client resilience as well as future-oriented discussions about hope and goal setting.

Staff uniformly agreed that a polyvictimization assessment could help them to better serve their clients. For example, some providers noted that asking about current housing or immigration challenges would enable them to provide appropriate referrals for services at the FJC or other partner agencies in the community. Others noted that the symptom questions on the PAT could be helpful in facilitating referrals for mental health treatment and other support services. Some staff also reported that the polyvictimization assessment process could be used to provide basic psychoeducation to clients, almost all of whom have significant trauma histories. Staff mentioned that the assessment process could be used to help clients recognize patterns among their adverse experiences, and to normalize their reactions to these experiences by drawing connections between polyvictimization and their reported symptoms.

Concerns about the assessment. Although staff identified several benefits of completing a polyvictimization assessment, they also expressed concerns about where and when the tool should be administered and what questions should be asked. All providers reported that the PAT should be administered in a private setting at the lead domestic violence agency to help clients feel safe disclosing their experiences and to protect client confidentiality. Staff expressed the concern that, if the assessment was completed at a partner agency such as the district attorney’s office, clients might feel compelled to disclose information based on the misperception that it could lead to restorative actions by the agency on their behalf.

Staff uniformly agreed that the PAT would be better suited for clients who have received services at the FJC for some time rather than completing the assessment with clients at intake. They noted that it is important for providers and clients to first establish trust and rapport before talking about trauma. In addition, staff indicated that they often need to attend to other immediate client needs at intake such as safety planning, housing, and medical issues. Thus, in addition to concerns that clients may not be ready to disclose sensitive information early in the service period, staff were concerned that they may not have the time required to appropriately administer a comprehensive and conversational polyvictimization assessment. Furthermore, the client advocates noted that many frontline staff do not have adequate training or experience with trauma assessment or how to address emotional discomfort when trauma is disclosed. They reasoned that all assessors would need training in assessment protocols, including scripts that would describe the purpose of the tool, address confidentiality concerns, and supply standard language to ask clients sensitive questions about victimization. In addition, staff felt that to implement the PAT appropriately it would be important for assessors to have basic interviewing and psychoeducation skills as well as knowledge of referral outlets to internal or external partner agencies. They were concerned, however, that the PAT currently offers no standardized scripts or scoring guidelines that would facilitate their conversations and referral decisions.

Staff also expressed specific concerns about the tool itself. Most notably, staff objected to the format of the PAT and the duration of time it takes to administer. With 44 items, each with different response options for childhood, adulthood, and the past year, it was not uncommon for the assessment process to last close to an hour when completed with advocates. Completing the PAT in one session would be challenging given restrictions on staff time and the need to attend to other important client goals. They noted that several items were duplicative (e.g., four sexual assault items) while other items (e.g., natural disaster; witnessing a dead body) were deemed nonessential for the population they serve. They recommended reducing the number of items while reserving more time for interaction and discussion with clients. Agency leaders also echoed this theme on multiple occasions during project meetings with the research team. In a related vein, some staff felt that the PAT was too rigid, suggesting that it should be a client-centered process that allows respondents to have some control over the assessment process. For instance, some staff preferred gathering information through client-led modalities such as art therapy or support groups. To the extent that structured trauma assessments are integrated into routine practice at the FJC, all staff recommended using briefer, validated tools that can serve as a catalyst for therapeutic discussions that help clients to process their traumatic experiences.

Synthesis of Findings

This study presents findings from a federally funded demonstration project that piloted a new PAT. Six FJCs participated in a process of developing and administering the tool under the leadership of a national technical assistance provider and an external evaluation team. Located in an urban area of the upper Midwest, the focal site of this study is one of the largest FJCs in the country. Prior data collected by the lead domestic violence agency at the Center suggest that, in addition to IPV, most clients have endured an array of adverse adult experiences such as partner/spouse substance abuse, discrimination, homelessness, and crime victimization as well as ACEs such as child maltreatment and witnessing domestic violence. Extending these findings, the current study synthesized qualitative data gathered from clients who completed the new polyvictimization assessment and staff who administered the tool.

Clients and providers noted several benefits of the assessment process. Clients emphasized that they were thankful for the invitation to talk about past trauma with an advocate with whom they had established trust. Clients also appreciated that staff used a client-centered approach to assessment, and as a result they felt empowered. Although disclosing trauma can be uncomfortable, clients felt that it could help them to process their own traumatic experiences while also enabling them to serve as an example for others on their healing journeys. Staff reported that the assessment process could offer clients the chance to tell their stories, and that it could also have instrumental value as a vehicle for providing psychoeducation and referrals for services to address trauma and other immediate needs.

While both groups felt there were benefits to assessing polyvictimization, they also expressed some concerns about the PAT as the tool for collecting this information. Some clients wanted to incorporate a stronger focus on coping and resilience, and they expressed the concern that clients might have adverse reactions to the process in the absence of strengths-based language to prepare clients for the assessment. Clients and staff recommended providing contextual information about the tool, including its purpose and how client confidentiality will be protected. Similarly, staff communicated that a trauma assessment should not be an exercise in just tallying the number of traumatic experiences an individual has experienced. Rather, it should also include conversations about a client’s strengths, goals, and hope for the future. Finally, staff expressed strong reservations about the length of the PAT, and they advocated for a shorter assessment with clear protocols that they could use to facilitate communication, psychoeducation, case planning, and service referrals.

Conclusions and Future Directions

Given the above findings, we conclude that future efforts to develop a polyvictimization assessment will be advanced by addressing 3 key questions. First, what forms of victimization and adversity are necessary to include in an assessment tool? Many events that were included in the PAT could be omitted, which would render a more parsimonious measure that would reduce administration time and burden. For instance, in alignment with the PTSD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the assessment could be restricted to measuring IPV and other high-magnitude stressors associated with actual or threatened death, serious injury, and witnessing or learning about a traumatic event (American Psychiatric Association, 2013). This framework has spawned many trauma checklists that can be used or adapted to measure polyvictimization (Gray et al., 2004; Kubany et al., 2000).

On the other hand, by focusing on extreme incidents that trigger posttraumatic reactions, the DSM-5 criteria for PTSD exclude less acute stressors such as partner substance use, housing insecurity, and discrimination that are nevertheless harmful because they tend to be recurring or chronic. The PAT captured these and other experiences that may compound the effects of IPV, especially among economically disadvantaged and marginalized populations. By incorporating a spectrum of adverse and potentially traumatic events, assessments may be more applicable to diverse practice settings, and they may aid providers in identifying and addressing the complex needs of diverse populations. Because trauma and its impact manifests in various ways, it could be argued that assessments should also account for an individual’s lived experience and unique perceptions of events. Thus, supplementing or supplanting structured assessment items with open-ended questions may empower clients during the assessment process to self-define their experiences. Moreover, counterbalancing questions about adversity with questions about coping, resilience, and hope may foster a strengths-based approach that facilitates positive provider-client interactions.

A second question pertains to the optimal context for conducting a polyvictimization assessment. That is, when should it be completed and in what setting? As noted by clients and staff, it is possible to conduct the assessment too early and too late. If the assessment is completed too soon, respondents may perceive that the questions do not address their immediate needs or they may experience discomfort with disclosure (Baker et al., 2010; Goodman et al., 2016; Lawson, 2017). Once immediate crises have been resolved, basic needs have been met, and relationships have been established, clients may be better prepared to focus on their victimization history and its psychosocial consequences. Conversely, if the assessment is postponed for an extended period, providers may miss out on opportunities to incorporate salient information into communication with clients and case planning. Client attrition is a pervasive challenge in many health and human service organizations, and the longer the delay in assessment the greater the probability that the information will never be gathered.

Regardless of when the assessment is completed, program staff and service recipients agreed that it should take place in a safe space, apart from children. Attention to the security of the physical space (e.g., gated parking, locked entry) and its aesthetics (e.g., soft lighting, welcoming décor) might help clients to feel more at ease during the assessment process. The FJC where the current project was completed takes these factors into consideration, and it has a centralized intake system that facilitates warm handoffs between colocated partner agencies and referrals to external providers.

Third, who should conduct the assessment and what kind of skills do they need? Mental health professionals have the clinical training and experience required to complete a trauma assessment successfully, though many victims never receive clinical care. Nonclinical providers who work one-on-one with clients are also well positioned to complete such an assessment, but some lack the self-efficacy to do so due to a lack of knowledge, experience, and clear protocols to guide their actions during and after the assessment (Salyers et al., 2004). Some may hesitate to ask sensitive questions out of concern for potential client discomfort or their own discomfort. Thus, practice guidelines and trainings are needed to enhance the competencies of the nonclinical professional corps that serves the large number of polyvictimized clients who seek assistance from community-based agencies such as FJCs.

One promising trauma-responsive protocol that has been developed to address this gap in care is Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT). Like Screening, Brief Intervention, and Referral to Treatment (SBIRT), a well-known intervention for alcohol and substance misuse (Babor et al., 2007), T-SBIRT is a brief, semistructured approach that can be used by trained, nonclinical professionals to connect adults with trauma-related symptoms to appropriate services (for training information, see Topitzes et al., 2019). The specific aims of T-SBIRT are to (a) identify trauma exposure and related symptoms using brief assessments, (b) use psychoeducation to help clients recognize the connection between trauma and their current functioning, and (c) use motivation enhancement techniques to engage clients and increase their acceptance of service referrals. Studies have shown that it is feasible to achieve these aims by implementing T-SBIRT in diverse contexts where client polyvictimization is a common concern, including federally qualified health centers, workforce development centers, and home visiting programs (Topitzes et al., 2019). In sum, the available evidence indicates that T-SBIRT equips providers with the skills and protocols they need to effectively complete a polyvictimization assessment and referral process. We look forward to further dissemination and evaluation of T-SBIRT in other service settings, including FJCs.

Appendix

List of Polyvictimization Events From the PAT.

Violence and abuse	Family or intimate partner assault Strangulation Sexual assault Unwanted sexual contact or sexual harassment Held against will Emotional abuse Financial abuse Human trafficking Stalking Neglect Bullying
Adverse life events	Poverty Homelessness Immigration-related trauma Permanent/long-term loss Hospitalization for severe illness/injury/mental illness Separation from children or parent (as a child) Discrimination Incarceration (self or someone else) Substance misuse (self or someone else) System-induced trauma Natural or man-made disasters
Witnessing violence or death	Community violence Animal cruelty Seen death/killing (not on TV/movie)
Other

Footnotes

Declaration of Conflicting Interests

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by U.S. Department of Justice (DOJ), Office of Justice Programs (OJP), Office for Victims of Crime (OVC) CFDA#16.582.

ORCID iDs

Danielle M. Romain Dagenhardt

Erin Schubert

Author Biographies

Danielle M. Romain Dagenhardt, PhD, is an assistant professor in the Department of Criminal Justice and Criminology at the University of Wisconsin-Milwaukee. Her research interests include court processing and gender and racial disparities in court decision-making. Her work has been published in journals including Feminist Criminology, Crime & Delinquency, and Journal of Criminal Justice Education.

Joshua Mersky, PhD, is a professor of social work in the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee. His research interests include the study of adversity and its implications for health and well-being over the life course and across generations. He applies his expertise toward developing, implementing, and disseminating effective intervention strategies in real-world settings to promote resilience.

James “Dimitri” Topitzes, PhD, LCSW, is a professor of social work in University of Wisconsin-Milwaukee’s Helen Bader School of Social Welfare and Director of Clinical Services for the Institute for Child and Family Well-being. He primarily conducts applied research and partners with community-based agencies to implement and test innovative trauma-responsive programming.

Erin Schubert, PhD, is the director of outcomes & evaluation at Sojourner Family Peace Center in Milwaukee, Wisconsin. Her work provides client feedback on programing and outcomes for survivors of intimate partner violence.

Amber E. Krushas is a doctoral student in the School of Criminology and Criminal Justice at the University of Nebraska—Omaha. Her research interests include female offenders, offenders with mental illnesses, and policy and program evaluation.

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